Med Surge 3, Exam 1

two types of acute cholecystitis

1. calculous cholecystitis ** most common 2. acalculous cholecystitis

ERCP can cause these 4 complications

1. cholangitis 2. pancreatitis 3. perforation 4. sepsis

Name 2 Gallbladder functions

1. collects, concentrates, and stores bile from the liver 2. releases bile into duodenum when fat is present

Name 2 Indication a T-tube is not working

1. decrease in drainage 2. stool has not returned to normal brown color

Lab values for cholecystitis

1. elevated WBC 2. ALT, AST, LDH increased 3. direct and indirect serum bilirubin levels increased 4. amylase and lipase increased with acute pancreatitis

Name 5 important Post-op teaching laparoscopic cholecystectomy

1. follow up appt 2. pain management 3. ambulation 4. apply heat to help with discomfort from CO2 5. shower day after surgery 6. return to work after 1 week 7. slow return to fat intake

After ERCP, it is important for the nurse to monitor what 4 things?

1. frequent vital signs until stable 2. gag reflex 3. NPO until gag reflex returns 4. teach patient to monitor for post-procedural complications (can develop days after procedures)

17 Risk factors for cholecystitis

1. gender - women 2x more likely (pregnant women - increased estrogen causes increased cholesterol) 2. aging - over age of 60 (related to cholesterol) 3. ethnicity (American Indian, Mexican Americans, caucasian) 4. obesity (increased cholesterol) 5. rapid weight loss, prolonged fasting (increases production of cholesterol in liver) 6. increased serum cholesterol 7. hormone replacement therapy, birth control pills 8. cholesterol lowering drugs 9. family history of gallstones 10. prolonged TPN 11. Chron's disease 12. gastric bypass surgery history 13. sickle cell disease 14. glucose intolerance/diabetes M. 15. pregnancy 16. genetic factors 17. sedentary lifestyle

Physical assessment of patient with suspected gallbladder problems

1. height, weight, vitals 2. nutrition/diet - foods high in cholesterol, fatty foods 3. abdominal pain? level? characterisitics

Define acalculous cholecystitis

1. inflammation of gallbladder not related to stones 2. associated with billiary stasis 3. caused by conditions that affect regular filling or emptying of gallbladder 3. commonly seen in very ill patients (sepsis, trauma, burns, long-term TPN, multisystem organ failure, hypovolemia)

Excessive fluid continues to be reabsorbed from the kidney because of the altered kidney perfusion and because ______ is not metabolized by the impaired liver.

Aldosterone

Endoscopic retrograde cholangiopancreatography (ERCP) is used for what?

Allowing visualization of lower GI - liver, pancreas, gallbladder, bile ducts

The nurse monitors for which clinical manifestation as indicative of a serious side effect of ribavirin (Virazole)?

Anemia

During the incubation period of viral hepatitis, ehat should the nurse expect the patient to report?

Anorexia and right upper quadrant discomfort

During the incubation period of viral hepatitis, the nurse would expect the patient to report. . .

Anorexia and right upper quadrant discomfort.

The nurse is caring for a patient who has undergone surgery to drain a pancreatic abscess with placement of a pancreatic drainage tube. Which nursing intervention will prevent complications from this procedure?

Applying a skin barrier around the drainage tube site.

Prior to calling the health care provider, which is the nurse's priority action for the patient with an increase in abdominal girth after undergoing a portal-systemic shunting procedure?

Assessing blood pressure

The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?

Assist the patient to the bathroom

When caring for a client who has cirrhosis, the nurse notices flapping tremors of the wrist and fingers. How should the nurse chart this finding?

Asterixis, also called liver flap, is the flapping tremor of the hands when the arms are extended.

The nurse correlates which findings in the patient with chronic persistant hepatitis?

Asymptomatic

the nurse is caring for a client with acute pancreatitis. the client is receiving bental 20 mg im 16h which assessment finding leads the nurse to clarify with the clients physician

the nurse does not hear any bowel sounds in the clients abdomen

Best initial diagnostic test for cholecystitis

ultrasongraphy of right upper quadrant

Name 4 Symptoms of chronic cholecystitis

1. jaundice 2. pruritis (itching) - due to obstruction of bile buildup of salts 3. streatorrhea/clay-colored stool (fatty stool) 4. dark urine/foamy - excess bilirubin

Signs and symptoms of chronic cholecystitis

1. jaundice of skin and mucous membranes 2. iclerus - discolored sclera

Name 5 Post-op nursing care for laparoscopic cholecystectomy

1. monitor pulse ox 2. breathing exercises hourly 3. monitor for signs of nausea/vomiting 4. elevated head of bed 5. ambulating early to help with absorption of CO2

5 characteristics most commonly associated with choleithiasis

1. obesity 2. age over 40 3. multiparous female 4. family history of gallbladder disease 5. use of estrogen or oral contraceptives

2 Complications of chronic cholecystitis

1. pancreatitis 2. cholangitis (bile duct inflammation)

Explain 4 characteristics of Cholelithiasis

1. presence of gallstones in the bladder 2. gallbladder becomes inflamed 3. blocks flow of bile 4. blocks flow of pancreas (causes pancreatitis)

4 things about Chronic cholecystits

1. repeated episodes of cholecystitis 2. almost always due to presence of gall stones 3. fibrotic tissue occurs 4. leads to complications

Patient should report these 4 symptoms of complications post ERCP

1. severe abdominal pain 2. fever 3. nausea and 4. vomiting

Clinical manifestations of cholecystitis

1. vague upper abdominal pain that comes and goes, can radiate to right shoulder 2. pain triggered by high-fat or high-volume meal 3. anorexia 5. nausea/vomiting 6. dyspepsia 7. eructation (belching) 8. flatulence 9. bloating 10. rebound tenderness (Blumberg's sign) 11. fever

Normal PT

11-13.5 seconds

The nurse includes which 3 teaching plans for the patient with viral hepatitis?

1. "Avoid all medications unless prescribed by physician" 2. "Increase intake of carbohydrates" 3. "Do not share razors or nail clippers"

The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (name 3 things)

1. Avoid nicotine 2. Eat bland foods. 3. Observe stools for steatorrhea

The nurse is instructing a patient with chronic pancreatitis on 3 measures to prevent further attacks. What information should be provided?

1. Avoid nicotine, 2. eat bland foods, 3. observe stools for steatorrhea

Risk factors associated with cholelithiasis:

1. Family history of gallbladder disease 2. Multiparous female 3. Obesity 4. Age over 40 5. Use of estrogen or oral contraceptives

Name 12 Post-op care for surgical traditional cholecystectomy

1. Jackson Pratt drain following (usually removed after first 24 hours) 2. drainage may be dark and green 3. IV antibiotics 4. post-op pain - PCA pump 5. coughing and deep breathing 6. splinting of incision (pillow, bath blanket) 7. monitor dressing, prevent dehissence 8. NPO until alert and oriented 9. low fat diet initially 10. teaching to avoid excess fatty foods 11. incision clean and dry 12. discharge 1-2 days (usually)

3 common Gallbladder lab tests

1. Liver function tests (LFTs) 2. serum amylase and 3. serum lipase

Which nursing actions are indicated for a liver biopsy patient (Name 3)

1. Monitor for internal bleeding 2. Position to right side after test 3. Check coagulation status before test

What are 4 signs and symptoms of pancreatitis?

1. N&V, 2 bloating, 3. Cullens sign (bluish color around umbilicus) or 4. flank (Turners sign) may signal hemorrhage.

Name 6 common Liver function test

1. PT/INR 2. Aspartate aminotransferase (AST) and 3.alanine aminotransferase (ALT) 4. bilirubin 5. albumin 6. serum amylase/serum lipase

The patient is an older woman with cirrhosis who also has anemia. Name 3 pathophysiologic changes may contribute to this patient's anemia.

1. Vit B deficiencies 2. Vascular congestion of spleen 3. Decreased prothrombin production

2 symptoms of postcholecystecomy syndrome

1. abdominal pain returns 2. vomiting *need to notify physician if this happens

name 3 Diagnostic assessment of cholecystitis

1. abdominal x-ray 2. ultrasound 3. ERCP - will help determine the cause

3 types of Medications to stop before ERCP

1. anticoagulants 2. antiplatelets 3. NSAIDs

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) black, tarry stools. b) circumoral pallor. c) light amber urine. d) yellow sclerae.

D) Yellow sclerae Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed.

A client is admitted to the same-day surgery unit after recovery from a laparoscopic cholecystectomy. Which action is the nurse's priority in caring for the client? A. Turn the client on the right side to help the flow of bile into drainage bag. B. Check that the NG tube is connected to low intermittent suction. C. Document the client's use of the PCA pump. D. Monitor the client's oxygen saturation level via pulse oximetry.

D. Monitor the client's oxygen saturation level via pulse oximetry.

Fluid moves into the abdominal cavity, producing ascites because of decreased serum oncotic colloidal pressure. The decreased serum oncotic pressure is caused by ______

Decreased albumin production

A patient is jaundiced and her stools are clay colored (gray). This is most likely related to

Decreased bile flow into the intestine.

Which manifestations may be seen in the patient with cirrhosis related to esophageal varices?

Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension

The patient experienced a blood transfusion reaction. How should the nurse explain to the patient the cause of the hemolytic jaundice that occurred?

Due to increased breakdown of RBCs that caused elevated serum unconjugated bilirubin

Which finding alerts the nurse to presence of hepatomegaly?

Dullness percussed over the liver

In a radical whipple procedure for treatment of cancer of the pancreas, what anatomic structure is completely resected that will affect the patient's nutritional status?

Duodenum adjoining the pancreas

Checking for the return of the gag reflex and monitoring for LUQ pain, nausea and vomiting are necessary nursing actions after which diagnostic procedure?

ERCP

The nurse is caring for an adult patient with possible cholecystitis. Which laboratory findings lead the nurse to beleive that this diagnosis is correct?

Elevated WBC count, 13,000/mm ElevatedAlanine aminotransferase (ALT), 66 IU/L Elevated Alkaline phosphatase (ALP), 106 U/L

Which laboratory findings does the nurse recognizes as a potential complication of liver disease?

Elevated prothrombin time and international normalized ratio (INR)

Which laboratory data does the nurse correlate with advanced disease in the patient with cirrhosis?

Elevated serum ammonia level

The nurse is caring for a patient with acute pancreatitis. During the physical assessment, the nurse notes the presence of Turner's sign. Which is the nurse's priority action?

Ensuring that the patient has a patent large-bore IV site.

A patient has just returned to the surgical unit following abdominal cholecystectomy with a T-tube in place. The nurse is aware that the surgeon should be notified if T-tube drainage:

Exceeds 1500 mL in 24 hours.

The nurse cares for the client diagnosed with acute cholecystitis. The client states, "My stomach hurts all the way up to my right shoulder. I am nauseated and have vomited twice." What should the nurse do FIRST?

Give Morphine 15 mg IM q4h PRN address pain to make client more comfortable before performing other orders

Following laparoscopic cholecystectomy, the nurse would expect the patient to. . .

Have four small abdominal incisions covered with small dressings

Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care?

Have up to four small abdominal incisions covered with small abdominal incisions covered with small dressings

Which of the following assessments made by the nurse could indicate the development of portal hypertension in a client with cirrhosis?

Hemorrhoids

The patient returned from a 6-week mission trip to Somalia with complaints of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted?

Hep E

the nurse is providing discharge teaching for a client who has undergone laparoscopic cholesytectomy surgery, which statement of the client indicates understanding of the instructions

I will have small low fat meals for the next several weeks

what to look for before removing t-tube

If the t-tube tolerates clamping by pt w. no symptoms it is ready to come out. if doing this and pt experience symptoms it is not ready to come out.

A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a peritoneovenous shunt. As a result of this procedure, the nurse would expect the patient to experience. . .

Improved hemodynamic function and renal perfusion

A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a portal caval shunt. As a result of of this procedure, what should the nurse expect the patient to experience?

Improved hemodynamic function and renal perfusion

Combined with clinical manifestations, what is the laboratory finding that is most commonly usedd to diagnose acute pancreatitis?

Increase serum amylase

Which clinical finding does the nurse expect to observe in the patient who had just undergone a peritoneovenous shunt placement?

Increased blood pressure

Combined with clinical manifestations, the lab findings that is most commonly used to diagnose acute pancreatitis is. . .

Increased serum amylase

A patient complains of leg cramps during hemodialysis. The nurse should first

Infuse a bolus of normal saline. Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.

What manifestation in the patient does the nurse recognize as an early sign of hepatic encephalopathy?

Is irritable and lethargic

The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. The nurse explains to the patient that this test. . .

Is noninvasive and is a very reliable method of detecting gallstones

When caring for a patient with autoimmune hepatitis, the nurse recognizes that, unlike viral hepatitis, the patient. . .

Is treated with corticosteroids or other immunosuppressant agents.

When caring for a patient with autoimmune hepatitis, the nurse understands that what in this patient is different from the patient who has viral hepatitis?

Is treated with corticosteroids or other immunosuppressive agents

What is characteristic of an ileal conduit?

It collects urine, kidneys work constantly, never irrigate, urine must be clear not cloudy, mucus in urine is common, empty q3hrs, tampon or rolled gauze to get bag to stick on, the bag is worn for over a year and clean with vinegar.

The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse explain to the patient about this test?

It is noninvasive and is a very reliable method of detecting gallstones

To treat a cirrhotic patient with hepatic encephalopathy, lactulose (Cephulac), rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the lactulose is ordered. What is the best explanation the nurse can give to the patient's family?

It traps ammonia and eliminates it in the feces

The nurse is caring for a patient who had kidney transplantation several years ago. Which assessment finding may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid?

Joint Pain Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.

What must the nurse do to care for a Ttube ina patient following a cholecystectomy?

Keep the tube supported and free of kinks.

The nurse is teaching the patient with a history of cholelithiasis to select menu items for dinner. Which selections made by the patient indicates the the nurse's teachings were effective?

Lasagna, tossed salad with Italian dressing, 2% milk

What kind of diet should someone with cholecystitis eat?

Low fat and calories, increased protein to re-build liver.

A patient with chronic kidney disease (CKD) brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required?

Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.

During the treatment of the patient with bleeding esophageal varices, it is most important that the nurse. . .

Maintain the patient's airway and prevent aspiration of blood

During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do?

Maintain the patient's airway and prevent aspiration of blood

The nurse is caring for a patient with acute pancreatitis. Which nursing intervention will best reduce discomfort for the patient?

Maintaining NPO status for the patient with IV fluids.

Which nursing intervention is a priority for the patient who has just undergone a paracentesis?

Maintaining bedrest

What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis?

Malabsorption and DM

What are the absolute contraindications for kidney transplantation?

Maligancy Active infection Active drug, tobacco, or illicit substance abuse Inability to comply with medical regime Acquired immune deficiency syndrome

Which medication does the nurse prepare to administer for the patient who is experiencing transplant rejection?

Methylprednisolone (Solu-Medrol)

Which finding in the patient receiving an infusion of vasopressin to treat bleeding esophageal varices indicates to the nurse a serious adverse effect of the drug?

Midternal chest pain

The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant?

Monitor closely for infection because of the immunosuppressive medication

Management of the patient with acute pancreatitis includes. . .

NG suction to prevent gastric contents from entering the duodenum

What treatment measure is used in the management of the patient with acute pancreatitis?

NG suction to prevent gastric contents from entering the duoenum

ERCP precautions

NPO 6-8 hours prior 2. no dentures in mouth 3. conscious sedation 4. no driving 12-18 hours after procedure 5. allergy to contrast media 6. determine if pacemaker present 7. meds to stop

What treatment for acute cholecystitis will prevent further stimulation of the gallbladder

NPO with NG suction

The nurse is caring for a female patient with cholelithiasis. Which assessment findings from the patient's history and physical examination may have contributed to the development of the condition? (select all)

Obesity The patient's BMI is 46 Multiple births The patient gave birth to twins 2 months ago. The patient has a history of metabolic syndrome. The patient's glycosylated hemoglobin level is 15%

A client was admitted to the hospital with cholelithiasis the previous day. Which of the following new assessment findings indicates to the nurse that the stone has probably obstructed the common bile duct?

Obstruction of the common bile duct results in reflux of bile into the liver, which produces jaundice.

The nurse caring for a client with uncomplicated cholelithiasis anticipates that the client's laboratory test results will show an elevation in what?

Obstructive biliary disease causes a significant elevation in alkaline phosphatase.

The patient has a diagnosis of a biliary obstruction form gallstones. What type of jaundice is the patient experiencing and what serum bilirubin results would be expected?

Obstructive jaundice with elevated unconjugated and conjugated bilirubin

What should the nurse do for a patient undergoing paracentesis?

Obtain consent, assess baseline vital and abdominal girth, HAVE THE PT VOID AND POSITION HIM, observe for hypovolemia during removal and observe fluid characteristics, measure abdominal girth for comparison, document and monitor for fever, pain, hematuria, or bleeding from puncture site. DON'T LET FLUID SIT SEND ORDERS TO LAB IMMEDIATELY!

The nurse uses which measurement technique in assessing abdominal girth?

Obtainting the measurement at the end of exhalation

The nurse recognizes which patient as at greatest risk for the development of carcinoma of the liver?

Older adult patient with a history of cirrhosis

Immediately following a liver biopsy, the nurse should position the client in which position?

On the right side after a liver biopsy, it is important to prevent leakage of fluid or hemorrhage from occurring; because of this, the idea position is to lie directly ON the liver with the ribs pushing on the liver; place a pillow under costal margin; determine prothrombin time, PTT, and platelet count prior to procedure; report abnormal findings to health care provider

When a patient who has had progressive chronic kidney disease (CKD) for several years is started on hemodialysis, which information about diet will the nurse include in patient teaching?

Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath.

Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis?

Pancreatic abscess

The nurse understands which of the following is the principal reason for the use of enzyme inhibitors (Diamox) in a patient with pancreatitis?

Pancreatic enzymes escape into interstitial tissue Diamox helps inactivate these enzymes to help minimize the damage they would cause to normal tissue

The spouse of a client with hepatitis B is given hepatitis B immune globulin (HBIg). The nurse understands this offers which type of protection?

Passive acquired

The retained fluid has low oncotic colloidal pressure, and it escapes into the interstitial spaces, causing _________

Peripheral edema

What action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?

The patient cleans the catheter while taking a bath every day. Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side.

The nurse is caring for a patient with a T-tube placed 3 days ago. Which assessment finding indicates to the nurse that the procedure was successful?

The patient had a soft, brown, formed stool this morning.

The nurse is caring for a patient with cholecystitis. Which assessment finding indicates to the nurse that the condition is chronic rather than acute?

The patient has clay-colored stools and dark amber urine.

The nurse is caring for a patient with cholecystitis. The patient is a poor historian and is unable to tell the nurse when the symptoms started. Which assessment finding indicates to the nurse that the condition is chronic rather than acute?

The patient has light-colored stoolls and dark amber urine.

Nonsurgical management of cholecystitis

1. avoid fatty foods 2. opioid analgesics - morhine or hydromorphone (dilaudid) 3. ketorolac (toradol, acular) - NSAIDs 4. antiemetics 5. gallstone dissolution agents - ursodiol (actigall) - dissolve cholesterol, stones 6. IV antibiotics 7. insertion of percutaneous transhepatic biliary catheter (T-Tube)

A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. The best response by the nurse is. . .

"A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile."

The nurse is caring for a postoperative patient who complains of pain in the shoulder blades following laparoscopic cholecystectomy surgery. Which direction will the nurse give to the nursing assistant to help relieve the client's pain?

"Ambulate the patient in the hallway."

A patient with cirrhosis asks that nurse about the possibility of a liver transplant. The best response by the nurse is. . .

"Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?"

A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse?

"Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?"

The nurse identifies a need for further teaching when the patient with hepatitis B makes which statement?

"I must avoid all physical contact with my family until the jaundice is gone."

The nurse identifies a need for further teaching when the patient with hepatitis B states. . .

"I must avoid all physical contact with my family until the jaundice is gone."

Which statement by the patient with alcohol induced cirrhosis indicates the need for further teaching?

"I need to avoid protein in my diet"

The nurse is providing discharge teaching for a patient who has undergone laparoscopic cholecystectomy surgery. Which statement by the patient indicates understanding of the instructions?

"I will have a low-fat diet with small, frequent meals."

The nurse is providing discharge information for a patient who will be going home with a T-tube following cholecystectomy surgery. Which statement by the patient indicates the need for additional teaching?

"I will irrigate the T-tube with normal saline if the drainage appears too slow"

The nurse is providing discharge teaching for a patient who will be receiving pancreatic enzyme replacement at home. Which statement by the patient indicates that additional teaching is needed?

"I will take the enzymes immediately after I have a meal or snack."

A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse?

"Interferon combined with lamivudine (Epivir) will decrease viral load and prevent complications"

Which is the nurse's best response to the patient receiving lactulose who reports ecperiencing several soft stools daily?

"This is the expected response to the medication"

The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse?

"Those who have had household or close contact with the patient should receive immune globulin"

The family member of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. The best response by the nurse is. . .

"Those who have had household or close contact with the patient should receive immune globulin."

A patient who underwent liver transplantation 2 weeks ago reports a temperature of 101 degrees and right flank pain. Which would be the nurse's best response?

"You may be rejecting the transplanted liver and should go to the hospital immediately"

For the patient diagnosed with hepatitis A asking how the infection may have been contracted, which response by the nurse is correct?

"You may have been exposed through contaminated shellfish"

The nurse incorporates which information into the teaching plan for the patient with severe esophageal varices who is scheduled for transjugular intrahepatic portal systemic shunt (TIPS) insertion?

"You will receive sedation, but the procedure may still be painful."

Most likely to develop acute cholecystitis. Name 4 important factors.

"the 4 Fs" 1. female 2. forty 3. fat 4. fertile

The patient being treated with diuretics for ascites from cirrhosis must be monitors for?

-Hypokalemia -Renal function

A patient was diagnosed with nonalcolic fatty liver disease. What treatment measures should the nurse plan to teach the patient about?

-Weight loss -diabetes -dietary management of hyperlipidemia

normal range of lypase

0-160

Normal AST levels

0-35

What is a normal bilirubin level and what might it indicate if it is high?

0.3-1.0 increased levels may indicate: 1. hemolysis 2. biliary obstruction 3. hepatic damage

The nurse is caring for a patient who is being discharged from the hospital after an attack of acute pancreatitus. Name 5 discharge instructions will the nurse provide for the patient to help prevent a recurrence?

1. ""Take a 20-minute walk at least 5 days a week." 2. "Attend local Alcoholics Anonymous (AA) meetings weekly." 3. "Use olive oil when you cook rather than margarine or butter." 4. "Stay away from milk and airy products that contain lactose." 5. "Use Tylenol (acetaminophen) rather than Motrin (ibuprofen) for pain."

normal range of albumin

3.5-5.0

Normal range of amylase

30-220

What should you expect to drain from a T tube?

300-500 ml of thick blood tinged, bright yellow to dark green bile the first 24 hours. After 4 days the amount will be less than 200 ml/day.

Normal ALT levels

4-36

The nurse cares for a patient after a traditional cholecystectomy. The nurse should contact the physician if which of the following is observed?

800 cc bloody drainage the first day postop this amount of drainage after a cholecystectomy would indicate hemorrhage; 50 cc is an appropriate amount of drainage

The nurse recognizes which patient as being at greatest risk of developing hepatitis B?

A college student who has had several sexual partners

The nurse correlates which rationale for a protien-restricted diet in the patient with portal-systemic encephalopathy (PSE)?

A low protein diet will help reduce the amount of ammonia in the blood

A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse?

A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile

Which diagnostic results lead the nurse to suspect that a client may have gallbladder disease? A. Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall B. Decreased WBC count, visualization of calcified gallstones, increased alkaline phosphatase C. Increased WBC count, visualization of noncalcified gallstones, edema of the gallbladder wall D. Decreased WBC count, visualization of noncalcified gallstones, increased alkaline phosphatase

A. Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall An increased WBC count is evidence of inflammation. Only calcified gallstones will be visualized on abdominal x-ray.

After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL

A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The dyspneic client is at greatest risk for rapid deterioration and requires immediate assessment and intervention.

The nurse correlates decreased hepatic synthesis of which substance in the patient who develops ascites?

Albumin

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it

AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.

In assessing a patient, the nurse correlates Kehr's sign with which finding?

Abdominal pain referred to the right shoulder

Which clinical sign would alert the nurse to the presence of possible liver trauma?

Abdominal pain reffered to the right shoulder

A patient with an obstruction of the common bile duct has clay-colored fatty stools, among other manifestations. What is the pathophysiologic change that causes this clinical manifestation

Absence of bile salts in the intestine and duodenum, preventing fat emulsion and digestion

In discussing long-term management with the patient with alcoholic cirrhosis, what should the nurse advise the patient?

Abstinence from alcohol is the most important factor in improvement of the patient's condition

In discussing long term management with the patient with alcoholic cirrhosis, the nurse advises the patient that. . .

Abstinence from alcohol is the most important factor in improvement of the patients condition.

What causes the systemic effects of viral hepatitis?

Activation of the complement system by antigen-antibody complexes

The systemic effects of viral hepatitis are caused primarily by. . .

Activation of the complement system of antigen-antibody complexes.

the nurse is caring for a client that just underwent the whipple procedure two days previously. the nurse notes that the clients hands and feet are edematous and urine output is decreased from the previous day, which intervention will the nurse expect to do for the client

Adding additional amino acids to the clients tpn solution

The nurse is providing discharge instructions for a client who has undergone a laparoscopic cholecystectomy. Which instruction will the nurse include in the discharge teaching? A. Keep dressing in place for 4 weeks. B. Report bile-colored drainage from any of the incisions. C. Expect dark, tarry stools after surgery. D. Be aware that no dietary changes will be necessary.

B

The nurse cares for a client diagnosed with cholelithiasis. It is MOST important to instruct the client to avoid which of the following foods? SELECT ALL THAT APPLY a) Apples b) Cabbage c) Lettuce d) Cheese e) Chocolate f) Carrots

b) Cabbage d) Cheese e) Chocolate Rational: avoid gas-forming vegetables such as onions, broccoli, radishes, beans, foods high in cholesterol/fat, egg yolks, avocado

A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority instruction for this client to avoid further attacks of pancreatitis? A. "You may need a surgical consult for removal of your gallbladder." B. "See your health care provider immediately when experiencing symptoms of a gallbladder attack." C. "If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider." D. "You'll need to drastically modify your alcohol intake."

B. "See your health care provider immediately when experiencing symptoms of a gallbladder attack."

The nurse suspects that which client is at highest risk for developing gallstones? A. Obese male with a history of chronic obstructive pulmonary disease B. Obese female on hormone replacement therapy C. Thin male with a history of coronary artery bypass grafting D. Thin female who has recently given birth

B. Obese female on hormone replacement therapy Both obesity and altered hormone levels increase a woman's risk for developing gallstones.

A new order for IV gentamicin (Garamycin) 60 mg BID is received for a patient with diabetes who has pneumonia. When evaluating for adverse effects of the medication, the nurse will plan to monitor the patient's ____________?

BUN and creatinine When a patient at risk for chronic kidney disease (CKD) receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels.

A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that

Bilirubin is not being conjugated and excreted into the bile by the liver. Rationale: Bilirubin is a pigment derived from the breakdown of hemoglobin and is insoluble in water. Bilirubin is bound to albumin for transport to the liver and is referred to as unconjugated. An indirect bilirubin determination is a measurement of unconjugated bilirubin, and the level may be elevated in hepatocellular and hemolytic conditions.

The nurse monitors for which complication in the patient with end-stage cirrhosis who develops severe vomiting?

Bleeding esophageal varices

Which conditions contribute to the formation of abdominal ascites?

Blood flow through the portal system is obstructed, which causes portal hypertension

The nurse gives discharge instructions to the family of a patient diagnosed with hepatic encephalopathy. The nurse determines further teaching is necessary if the family makes which of the following statements? a) We should contact the physician if Dad is restless at night." b) "Cephulac will cause Dad to have 2-3 stools per day." c) "Dad should eat meat at every meal." d) "Cephulac may cause bloating and cramps.

C. "Dad should eat meat at every meal." low-protein, high-calorie diet for clients with hepatic encephalopathy

A client diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? A. "This may be an indication that you are developing sepsis." B. "The gallstones are present, but have become fibrotic and contracted." C. "This type of gallbladder inflammation is associated with hypovolemia." D. "This may be an indication of pancreatic disease."

C. "This type of gallbladder inflammation is associated with hypovolemia."

The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? A. Deceased calcium, elevated amylase, decreased magnesium B. Elevated bilirubin, elevated alkaline phosphatase C. Elevated lipase, elevated white blood cell count, elevated glucose D. Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

C. Elevated lipase, elevated white blood cell count, elevated glucose Elevated lipase is more specific to a diagnosis of acute pancreatitis.

The nurse is teaching a client with gallbladder disease about diet modification. Which meal does the nurse suggest to the client? A. Steak and French fries B. Fried chicken and mashed potatoes C. Turkey sandwich on wheat bread D. Sausage and scrambled eggs

C. Turkey sandwich on wheat bread Turkey is an appropriate low-fat selection for this client. Steak, French fries, fried chicken, and sausage are too fatty, and eggs are too high in cholesterol for a client with gallbladder disease.

Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?

Calculated glomerular filtration rate (GFR) GFR is the preferred method for evaluating kidney function.

A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV?

Cardiac Rhythm The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.

After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first?

Check the chart for the most recent blood potassium level. The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider.

When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula?

Check the fistula site for a bruit and thrill. The presence of a thrill and bruit indicates adequate blood flow through the fistula.

Shortly following a meal, a 49-year-old female complains of acute pain to the right upper quadrant of her abdomen with referred pain to her right shoulder. This is MOST suggestive of acute:

Cholecystitis.

The patient tells the nurse she had a history of abdominal pain, so she had a surgery to make an opening into the common bile duct to remove stones. The nurse knows that this surgery is called a

Choledocholithotomy is an opening into the common bile duct for the removal of stones.

A big risk factor associated with cancer of the pancreas is. . .

Cigarette smoking

What is a big risk factor associated with cancer of the pancreas?

Cigarette smoking

The nurse monitors for which clinical manifestation in the patient with a decreased fecal urobilinoegen concentration?

Clay-colored stools

The nurse correlates which action to the administration of vasopressin for the patient with bleeding esophageal varices?

Constriction of preportal splanchnic arterioles

The nurse cares for a client with a Sengstaken-Blakemore tube to treat bleeding esophageal varices. The client suddenly develops respiratory distress. Which action should the nurse take FIRST?

Cut the balloon port on the Sengstaken-Blakemore tube keep a pair of scissors at bedside; cutting the port will deflate the balloon and allow the nurse to remove the tube

The ED nurse has inspected, auscultated, and palpated the abdomen with no obvious abnormalities, except pain. When the nurse palpates the abdomen for rebound tenderness, there is severe pain. The nurse should know that this could indicate what problem?

Peritoneal inflammation When palpating for rebound tenderness, the problem area of the abdomen will produce pain and severe muscle spasm when there is peritoneal inflammation.

In a patient with acute kidney injury (AKI) who requires hemodialysis, a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which intervention will be included in the plan of care?

Place the patient on bed rest The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein.

Esophageal varices are the most common complication of what?

Portal hypertension

A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in the patient's plan of care.

Position the patient on the side with the head of the bed elevated 45 degrees for pain relief

A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of pancreas and peritoneal irritation. In addition to effective use of analgesics, the nurse should. . .

Position the patient on the side with the head of the bed elevated 45 degrees for pain relief.

A patient with hypertension and stage 2 chronic kidney disease (CKD) is receiving captopril (Capoten). Before administration of the medication, the nurse will check the patient's ___________________?

Potassium Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia.

After eating, a patient with an inflamed gallbladder experiences pain caused by contraction of the gallbladder. What is the mechanism responsible for this action?

Production of cholecystokinin by the duodenum

For the patient with cirrhosis, which nursing intervention would be most effective in controlling fluid accumulation in the abdominal cavity?

Providing a low-sodium diet

One of the most challenging nursing interventions to promote healing in the patient with viral Hepatitis is . . .

Providing adequate nutritional intake

What is one of the most challenging interventions to promote healing in the patient with viral hepatitis?

Providing adequate nutritional intake

What is the correct way to manage a T-tube?

Put on sterile gloves clean around tube with NaCL, air dry then apply petroleum jelly around tube to protect skin, and put a sterile precut dressing around tube.

The health care team is assessing a male patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which laboratory value is the best diagnostic indicator of acute pancreatitis?

Rationale: Elevated serum amylase levels indicate early pancreatic dysfunction and are used to diagnose acute pancreatitis. Serum lipase levels stay elevated longer than serum amylase in acute pancreatitis.

The nurse understands which of these factors is the MOST likely source of hepatitis D? a) Eating infected shellfish b) Overly exerting oneself c) Practicing poor hygiene d) Receiving a blood transfusion

Receiving a blood transfusion hepatitis D co-infects with hepatitis B; spread by contact with blood and bodily fluids

As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the

Release of bicarbonate by the pancreas. Rationale: The hormone secretin stimulates the pancreas to secrete fluid with a high concentration of bicarbonate. This alkaline secretion enters the duodenum and neutralizes acid in the chyme.

After cholecystectomy, a patient is returned to the unit with a nasogastric tube connected to low intermittent suction, an IV of D5W, a T-tube in place and a Penrose drain. The nurse understands that the purpose of the Penrose drain is

Remove accumulated bile and blood after surgery duct must be allowed to drain; bile would otherwise drain into surrounding tissue, be very caustic, and cause problems for the patient

During discharge instructions for a patient following a laparoscopic cholecystectomy, the nursing advises the patient to. . .

Report and bile colored or purulent drainage from the incisions.

During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching?

Report any bile-colored or purulent drainage from the incisions.

What are 5 signs and symptoms of cholecystitis?

Right upper quadrant or epigastric pain (NO MORPHINE), increased pain with deep breath, N&V, abd distention, and jaundice.

The nurse cares for a patient after a traditional cholecystectomy. It is MOST important for the nurse to position the patient in which of the following positions?

Semi-Fowler's semi-Fowler's is optimal for the patient because it will allow her to take the necessary deep breaths that are important to prevent pneumonia after surgery; supine with bed flat is a position difficult to breath in and would place tension on the suture line

Which laboratory result will the nurse expect to find in a patient with pancreatitis?

Serum amylase, 625 IU/L

When assessing a patient with acute pancreatitis, the nurse would expect to find. . .

Severe midepigastric or LUQ pain

When assessing a patient with acute pancreatitis, the nurse would expect to find

Severe midepigastric or left upper quadrant pain

The nurse is caring for a client who has ascites and the health care provider prescribes spironolactone (Aldactone). The client asks why this drug is being used. Which is the best response by the nurse?

Spironolactone (Aldactone) is used in clients with ascites that show no improvement with bedrest and fluid restriction. It inhibits sodium reabsorption in the distal tubule and promotes potassium retention by inhibiting aldosterone.

Which nursing intervention is the priority in the patient being treated for bleeding esophageal varices with an esophagogastric tube?

Suctioning the oral cavity of secretions

A patient id hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge?

Supportive care that is appropriate for all patients with severe liver damage is indicated

In reveiwing patient charts, which finding by the nurse correlates with an increased risk for developing hepatorenal syndrome secondary to cirrhosis?

Taking acetaminophen for pain

In caring for the client 4 days post-cholecystectomy, the nurse notices that the drainage from the T-tube is 600mL in 24 hours. Which is the appropriate action by the nurse? 1. Clamp the tube q2h for 30 minutes

The T-tube may drain 500mL in the first 24 h and decreases steadily thereafter. If there is excessive drainage, the nurse should further assess the drainage to be able to describe it accurately and notify the physician immediately.

The nurse is caring for a patient with acute pancreatitis. The patient is to receive dicyclomine (Bentyl), 20 mg IM, every 6 hours. Which assessment finding leads the nurse to clarify the order with the patient's physician?

The nurse does not hear any bowel sounds in the patient's abdomen.

Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check the laboratory value for

serum phosphate. If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered.

What should you teach your pt about a liver biopsy? (before, during, and after)

They should avoid aspirin, NSAIDs, and anticoagulants for at least 2 weeks prior and they should fast 6 hours before exam. During the procedure they will be positioned on their left side or supine with their right arm above head, the pt should exhale and hold breath while needle is inserted. After the procedure the patient should lie on his/her right side for 2 hours (plug).

Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation?

Urine Output Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour.

A patient is admitted to the hospital with left upper quadrant (LUQ) pain. What may be a possible source of the pain?

The pancreas is located in the left upper quadrant, the liver is in the right upper quadrant, the appendix is in the right lower quadrant, and the gallbladder is in the right upper quadrant.

The occurrence of acute liver failure is most common in which situation?

Use of acetaminophen with alcohol abuse

The post-cholecystectomy client asks the nurse when the T-tube will be removed. Which of the following responses by the nurse would be appropriate?

When T-tube drainage declines and the stools return to a normal brown color, the tube can be clamped 1 to 2 hours before and after meals in preparation for tube removal. If the client tolerates clamping, the tube will then be removed.

When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation? a. The patient has metastatic lung cancer. b. The patient has poorly controlled type 1 diabetes. c. The patient has a history of chronic hepatitis C infection. d. The patient is infected with the human immunodeficiency virus.

a. The patient has metastatic lung cancer. Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.

Most common type of kidney cancer

adenocarcinoma

the nurse is caring for a postoperative client, the clients complains of pain shoulder blades are in following laparoscopic cholecystectomy surgery. which direction will the nurse give to the nursing assistant to help relieve the clients pain

ambulate the client in the hallway

The nurse in the outpatient clinic is counseling a client with a diagnosis of cholecystitis. The nurse determines teaching is successful if the client makes which of the following statements? a) "I really like a lot of cream in my oatmeal." b) "We eat a lot of broiled fish and chicken." c) "I can't wait to eat the chocolate my children gave me." d) "My favorite dish is broccoli with cheese and sauce."

b) "We eat a lot of broiled fish and chicken." patients with cholecystitis should eat foods high in protein and low in fat, such as broiled lean meats; cooked fruits, non-gas forming veggies, and bread.

The nurse instructs a client about appropriate foods for a high-protein diet. The nurse determines teaching is effective if the client chooses which menu? a) Chef salad, crackers, and iced tea b) Broiled fish, cream of tomato soup topped with grated cheese, and custard c) Peanut butter and jelly sandwich, chips, and fruit drink d) Turkey sandwich with lettuce and tomato, potato salad, and milk

b) Broiled fish, cream of tomato soup topped with grated cheese, and custard all foods contain protein; increase protein by adding skim milk to soup, add grated cheese to foods, use peanut butter as spread on fruits and veggies, use yogurt as topping for fruit and cake

Which symptoms of liver disease should the nurse expect to see in a client with Laënnec 's cirrhosis? a) Cloudy urine b) Dark urine c) Orange-colored stools d) Tarry stools

b) Dark urine normally bilirubin is not excreted in urine; urine with abnormal bilirubin is mahogany-colored and has yellow foam when shaken; clients with cirrhosis may have clay-colored stools due to decreased fecal urobilinogen

The nurse identifies which diet BEST meets the nutritional needs of a client diagnosed with cirrhosis? a) High in calories plus vitamin supplements b) High in protein and high in carbohydrates c) High in calcium and low in fat d) High in iron and low in salt

b) High in protein and high in carbohydrates since many alcoholics are malnourished, a high-protein diet is important

A patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and an elevated blood urea nitrogen (BUN) and creatinine. Which of these prescribed therapies should the nurse implement first? a. Obtain renal ultrasound. b. Insert retention catheter. c. Infuse normal saline at 50 mL/hour. d. Draw blood for complete blood count.

b. Insert retention catheter. The patient's elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient.

A sexual contact of a patient with hepatitis B is given HBIg. The nurse explains to the contact the purpose of the medication is to

temporarily increase the person's resistance to hepatitis an injection of pooled human gamma globulin is an example of passive immunity; there is no guarantee that he won't develop hepatitis

Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance

b. Phosphate level Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD.

When caring for a dehydrated patient with acute kidney injury who is oliguric, anemic, and hyperkalemic, which of the following prescribed actions should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).

b. Place the patient on a cardiac monitor. Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm.

The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which information should be reported immediately to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient complains of feeling bloated after the inflow.

b. The patient's peritoneal effluent appears cloudy. Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started.

The nurse obtains a history from a client suspected of having cirrhosis. Which statement, if made by the client to the nurse, should the nurse recognize as MOST directly related to a client's development of cirrhosis? a) "For the past several weeks I have not slept for more than five hours a night." b) "Since my spouse left me five years ago, I have been eating terribly." c) "I have been drinking about a fifth of vodka a day for the last few months." d) "My spouse was a heavy smoker, and I am concerned about second-hand smoke."

c) "I have been drinking about a fifth of vodka a day for the past few months." alcohol has a toxic effect on the liver, which causes liver inflammation; s/s include N/V, anorexia, weight loss, flatulence, fatigue, headache, ascites, jaundice, and spider angiomas

nurse caring for a client with cholecystitis. which alerts the nurse the condition chronic rather than acute

the client has clay colored stools and amber urine

During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Obtain blood to check the blood urea nitrogen (BUN) level. c. Check the patient's blood pressure. d. Give prescribed PRN antiemetic drugs.

c. Check the patient's blood pressure. The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions also may be appropriate, based on the blood pressure obtained.

Which of the following information obtained by the nurse who is caring for a patient with end-stage renal disease (ESRD) indicates the nurse should consult with the health care provider before giving the prescribed epoetin alfa (Procrit)? a. Creatinine 1.2 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg

c. Hemoglobin level 13 g/dL High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when EPO is administered to a target hemoglobin of >12 g/dL. Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose.

A patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which of these orders for the patient will the nurse question? a. NPO for 6 hours before IVP procedure b. Normal saline 500 mL IV before procedure c. Ibuprofen (Advil) 400 mg PO PRN for pain d. Dulcolax suppository 4 hours before IVP procedure

c. Ibuprofen (Advil) 400 mg PO PRN for pain The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided.

Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse? a. The blood glucose is 144 mg/dL. b. The patient's blood pressure is 150/92. c. There is a nontender lump in the axilla. d. The patient has a round, moonlike face.

c. There is a nontender lump in the axilla. A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy.

Which information about a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration will be most important for the nurse to report to the health care provider? a. The blood urea nitrogen (BUN) level is 67 mg/dL. b. The creatinine level is 3.0 mg/dL. c. Urine output over an 8-hour period is 2500 mL. d. The glomerular filtration rate is <30 mL/min/1.73m2.

c. Urine output over an 8-hour period is 2500 mL. The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy

A patient withAKI and severe heart failure develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet the goal of a. replacing fluid volume. b. preventing hypertension. c. maintaining cardiac output. d. diluting nephrotoxic substances.

c. maintaining cardiac output. The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover.

Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess the a. blood urea nitrogen (BUN) and creatinine. b. blood glucose level. c. patient's bowel sounds. d. level of consciousness (LOC).

c. patient's bowel sounds. Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur.

most common type of gall stone

cholesterol stones

when fecal urobilinogen concentration levels are decreased as result of biliary cirhosis the stool becomes ________________?

clay colored stools

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for a. vasodilation. b. poor skin turgor. c. bounding pulses. d. rapid respirations.

d. rapid respirations. Rationale: Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide.

which effect does the nurse expect daily cortisol therapy to have on clients circulatory levels of acth and aldosterone,

decrease aldosterone and acth

In liver disease, albumin levels will be ________________?

decreased

Blumberg's sign

deep palpation and quickly removed causing pain *sign of peritonitis

the nurse is caring for a client who has been just diagnosed with end state pancreatic cancer. the nurse assess the clients emotional response to the diagnosis. which is the nurses initial action for assessment

determine if the client feels like talking about his or her feelings

the nurse is caring for a client who has undergone a traditional cholesytectomy surgery, the drain is in place, the nurse notes that there is serousanguines drainage is present in the drain, which is the nurses priority action

documenting the findings in the clients chart

during a physical assessment the nots the presence of turners sign which is the nurses priority action

ensuring the client has a patent large bore IV site

the nurse recognizes that fector hepaticus is consistent with which assessment finding

fruit or musty breath odor

Calculous cholecystitis is caused by

gallstones (cholelithiasis) that obstruct the cystic duct*, gallbladder neck, or common bile duct

The patient with chronic pancreatitis is more likely than the patient with acute pancreatitis to. . .

have malabsorption and diabetes mellitus

Abdominal assessment should follow what sequence?

he abdomen should be assessed in the following sequence: inspection, auscultation, percussion, palpation.

the nurse is caring for a client with chronic pancreatitis, which statement by the client indicates additional teaching is needed

i will avoid simple carbohydrates and concentrated sweet

which clinical finding does the nurse expect to find observe in a client who has just undergone peritoneal shunt replacement

increase blood pressure

Elevation of AST and ALT may indicate what 3 problems?

increased levels may indicate: 1. liver disease 2. hepatitis 3. cirrhosis

Define cholecystitis

inflammation of gallbladder

The nurse recognizes early signs of hepatic encephalopathy in the patient who. . .

is irritable and lethargic

the client with obstructive jaundice asks why his skin is so itchy. what is the nurses best response

itching is caused by accumulation of bile salts on the skin

To care for a t-tube in a patient following a cholecystectomy, the nurse. . .

keeps the tube supported and free of kinks

albumin is made in the ___________________

liver

amylase is secreted by the _____________________?

pancreas

lypase is secreted by the ______________________?

pancreas into small intestine

elevation in serum amylase levels will indicate ________________?

pancreatitis

for the client with cirrhosis which nursing intervention would be most effective in fluid accumulation in the abdominal cavity

providing a low sodium diet

Most reliable test for diagnosing pancreatitis is __________________?

serum lypase